Radio Graphic Aids - Diagnosis Periodontal Diseases Kalps Ppt
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Transcript of Radio Graphic Aids - Diagnosis Periodontal Diseases Kalps Ppt
RADIOGRAPHSRADIOGRAPHSININ
THE DIAGNOSISTHE DIAGNOSISOFOF
PERIODONTAL DISEASEPERIODONTAL DISEASE
RADIOGRAPHSRADIOGRAPHS
Diagnosis of periodontal diseaseDiagnosis of periodontal disease
Determination of prognosis Determination of prognosis
Evaluation of outcome of treatment plan.Evaluation of outcome of treatment plan.
YETYET
Radiograph is an Radiograph is an adjunct to clinicaladjunct to clinical examination but not a substitute for it.examination but not a substitute for it.
RADIOGRAPHRADIOGRAPHADJUNCT ADJUNCT NOT NOT A SUBSTITUTEA SUBSTITUTE
Radiograph reveals alterations in calcified Radiograph reveals alterations in calcified tissue tissue
it does not reveal current cellular activity it does not reveal current cellular activity
BUTBUT
shows the effects of past cellular shows the effects of past cellular experience on the bone & roots.experience on the bone & roots.
NORMAL INTERDENTAL SEPTANORMAL INTERDENTAL SEPTA
In normal radiographs a thin layer of In normal radiographs a thin layer of opaque cortical bone often covers alveolar opaque cortical bone often covers alveolar crest.crest.
The height of the crest lies at a level 1-1.5 The height of the crest lies at a level 1-1.5 mm below CEJ of adjacent teeth.mm below CEJ of adjacent teeth.
Between posterior teeth alveolar crest is Between posterior teeth alveolar crest is parallel to a line connecting adjacent CEJparallel to a line connecting adjacent CEJ
NORMAL INTERDENTAL SEPTANORMAL INTERDENTAL SEPTA
Alveolar crest in anterior teeth is pointed Alveolar crest in anterior teeth is pointed A well mineralized cortical outline of A well mineralized cortical outline of alveolar crest indicates absence of alveolar crest indicates absence of periodontitis activity.periodontitis activity.Alveolar crest is continuous with the Alveolar crest is continuous with the lamina dura lamina dura Radiographic changes in periodontal Radiographic changes in periodontal disease is based mainly on the disease is based mainly on the appearance of interdental septa appearance of interdental septa
PRICHARD’S 4 CRITERIA FOR PRICHARD’S 4 CRITERIA FOR RG RG WITH GOOD ANGULATIONWITH GOOD ANGULATION
The radiograph should show the tips of The radiograph should show the tips of molar cusps with little or none of the molar cusps with little or none of the occlusal surface showing.occlusal surface showing.
Enamel caps & pulp chambers should be Enamel caps & pulp chambers should be distinct.distinct.
Inter proximal spaces should be open.Inter proximal spaces should be open.
Proximal contacts should not overlap Proximal contacts should not overlap unless teeth are out of line anatomically.unless teeth are out of line anatomically.
WHAT TO CHECK IN A WHAT TO CHECK IN A RADIOGRAPHRADIOGRAPH
Amount of bone loss.Amount of bone loss.Condition of alveolar crests.Condition of alveolar crests.Bone loss in furcation areas.Bone loss in furcation areas.Width of PDL space.Width of PDL space.Calculus & overextended restorationsCalculus & overextended restorationsRoot length & morphology & crown to Root length & morphology & crown to root ratio.root ratio.Peri apical lesionsPeri apical lesions
BONE DESTRUCTIONBONE DESTRUCTIONPERIODONTAL DISEASEPERIODONTAL DISEASE
Radiograph does not reveal minor Radiograph does not reveal minor destructive changes in bone destructive changes in bone
So slight radiographic changes means the So slight radiographic changes means the disease has progressed beyond its earliest disease has progressed beyond its earliest stages.stages.
Difference between clinical & radiographic Difference between clinical & radiographic alveolar crest is 0-1.6 mm.alveolar crest is 0-1.6 mm.
AMOUNT OF BONE LOSSAMOUNT OF BONE LOSS
Radiograph is an indirect method for Radiograph is an indirect method for determining the amount of bone loss. determining the amount of bone loss.
WHYWHY
It shows the amount of bone remaining It shows the amount of bone remaining rather than amount lost.rather than amount lost.
The amount of bone loss is difference The amount of bone loss is difference between the physiologic bone level & the between the physiologic bone level & the height of remaining bone.height of remaining bone.
PATTERN OF BONE PATTERN OF BONE DESTRUCTIONDESTRUCTION
In periodontal disease, the interdental In periodontal disease, the interdental septa undergo changes that affect the septa undergo changes that affect the
Lamina duraLamina dura
Crestal radiodensityCrestal radiodensity
Size & shape of medullary spacesSize & shape of medullary spaces
Height & contour of the boneHeight & contour of the bone
PATTERN OF BONE PATTERN OF BONE DESTRUCTIONDESTRUCTION
Horizontal bone loss Horizontal bone loss
Vertical bone loss Vertical bone loss
Interdental Craters Interdental Craters
Changes in the facial & lingual surfaces of Changes in the facial & lingual surfaces of bone cannot be seen in the radiograph bone cannot be seen in the radiograph because this can be obscured by dense because this can be obscured by dense root structure.root structure.
SEQUENCE OF CHANGESSEQUENCE OF CHANGESPERIODONTITISPERIODONTITIS
Fuzziness & a break in the continuity of Fuzziness & a break in the continuity of the lamina dura at interdental septumthe lamina dura at interdental septumA wedge shaped radiolucent area at crest A wedge shaped radiolucent area at crest of septal bone. of septal bone. Destruction extends across the crest of Destruction extends across the crest of inter dental septum & the height is inter dental septum & the height is reduced reduced The height of the inter dental septum is The height of the inter dental septum is progressively reduced progressively reduced
FURCATIONFURCATION
The slightest change in the furcation area The slightest change in the furcation area should be examined clinically, especially if should be examined clinically, especially if there is bone loss on adjacent roots.there is bone loss on adjacent roots.
Diminished radiodensity in the furcation area in Diminished radiodensity in the furcation area in which outlines of bony trabeculae are visible which outlines of bony trabeculae are visible suggests furcation involvement suggests furcation involvement
Whenever there is marked bone loss in Whenever there is marked bone loss in relation to a single molar root, it may be relation to a single molar root, it may be assumed that the furcation is also involved.assumed that the furcation is also involved.
Radiographic appearances of the Radiographic appearances of the periodontal abscessperiodontal abscess
discrete area of radiolucency along the discrete area of radiolucency along the lateral aspect of the root lateral aspect of the root
BUT NOT SEEN ALWAYSBUT NOT SEEN ALWAYS
Stage of the lesion Stage of the lesion
Extent of bone destruction & morphology Extent of bone destruction & morphology of bony changes of bony changes
Location of the abscess Location of the abscess
LJPLJP
Bone loss in the incisors & first molarsBone loss in the incisors & first molars
Bilateral , angular defects, arclike Bilateral , angular defects, arclike destructive patterns.destructive patterns.
Bone loss becomes generalized as the Bone loss becomes generalized as the disease progresses.disease progresses.
TFOTFO
TFO produces radiographic changes in:TFO produces radiographic changes in:– lamina duralamina dura– Morphology of the alveolar crestMorphology of the alveolar crest– Width of the PDL space andWidth of the PDL space and– Density of the surrounding cancellous boneDensity of the surrounding cancellous bone
TFOTFO
Radiographic signs of TFO may include Radiographic signs of TFO may include the following:the following:
Increased width of the periodontal space,Increased width of the periodontal space,
thickening of the lamina dura along the thickening of the lamina dura along the lateral aspect of the root, in the apical lateral aspect of the root, in the apical region, and in bifurcation areas.region, and in bifurcation areas.
A "vertical" rather than "horizontal" A "vertical" rather than "horizontal" destruction of the inter dental septumdestruction of the inter dental septum
Skeletal disturbances Skeletal disturbances manifested in jawsmanifested in jaws
Osteitis Fibrosa CysticaOsteitis Fibrosa Cystica
Paget’s disease Paget’s disease
Fibrous Dysplasia Fibrous Dysplasia
Langerhan’s cell histiocytosis Langerhan’s cell histiocytosis
Multiple Myeloma Multiple Myeloma
Osteopetrosis/Marble bone disease Osteopetrosis/Marble bone disease
Scleroderma Scleroderma
OSTEITIS FIBROSA CYSTICAOSTEITIS FIBROSA CYSTICA
Seen in advanced hyperparathyroidism. Seen in advanced hyperparathyroidism. Results in osteoclastic resorption of bone Results in osteoclastic resorption of bone with fibrous replacement & hemorrhage with fibrous replacement & hemorrhage with hemosiderin deposition.with hemosiderin deposition.
Brown tumor→ Diffuse, granular, mottling, Brown tumor→ Diffuse, granular, mottling, scattered cyst like radiolucent areas scattered cyst like radiolucent areas throughout the jaw & generalized throughout the jaw & generalized disappearance of lamina dura.disappearance of lamina dura.
PAGETS DISEASEPAGETS DISEASE
Normal trabecular pattern is replaced by a Normal trabecular pattern is replaced by a hazy, diffuse meshwork & generalized loss hazy, diffuse meshwork & generalized loss of lamina dura.of lamina dura.
FIBROUS DYSPLASIAFIBROUS DYSPLASIA
Ground glass appearance of bone Ground glass appearance of bone with obliteration of lamina dura.with obliteration of lamina dura.
HISTIOCYTOSISHISTIOCYTOSIS
Results from disturbances in immuno Results from disturbances in immuno regulation but changes seen are multiple regulation but changes seen are multiple radiolucent areas, which may be unrelated radiolucent areas, which may be unrelated to teeth or loss of tooth supporting bone.to teeth or loss of tooth supporting bone.
MULTIPLE MYELOMAMULTIPLE MYELOMA
Numerous radiolucent areas in jaws.Numerous radiolucent areas in jaws.
OSTEOPETROSISOSTEOPETROSIS
diffuse radio opacity of jaws which diffuse radio opacity of jaws which obscure the roots of teeth.obscure the roots of teeth.
SCLERODERMASCLERODERMA
periodontal ligament is uniformly periodontal ligament is uniformly widened at the expense of the widened at the expense of the surrounding alveolar bone.surrounding alveolar bone.